Sports Medicine

Over-use Injury Prevention

Maximizing performance for running, swimming and biking requires the athlete to improve conditioning by overloading (slightly surpassing present functioning levels) both the cardiovascular (heart and lungs) and the orthopaedic systems (bones, muscles, ligaments and tendons). However, excessive overload surpasses the tissues’ ability to adapt to the increased level of stress and over-use injury will occur. Therefore, the athlete must be very cautious in selecting an appropriate overload, which will provide optimal conditioning without producing injury.

Cardiovascular Versus Orthopaedic Conditioning

Many athletes sustain over-use injuries because they advance their conditioning programs when the present exercise intensity is comfortable. Perceived exertion (how hard the exercise session feels) is determined by the status of conditioning of the cardiovascular system. Because the cardiovascular system improves at a faster rate than the orthopaedic system, reliance on perceived exertion to determine the conditioning program will provide excessive stress to the orthopaedic system. Therefore, the intensity and/or duration of the conditioning program should be increased by 10% per week to allow the orthopaedic system time to adapt to the stress provided by exercise.

Hard Day, Easy Day

Maximum gains in conditioning are obtained when appropriate rest is provided, along with exercise, to enable the tissues to adapt and increase in function. Inadequate rest increases the probability of sustaining an injury. Intense workouts should be followed by a light workout the next day.

Progression of Over-Use Injuries

Over-use injuries can be prevented if the athlete is familiar with the progression of injury and modifies the workout prior to the onset of injury. Over-use injuries usually progress through stages, which include benevolent pain, semi-harmful pain and harmful pain.

Benevolent Pain

Like it’s name sounds, this is good pain. It is a normal result of overload within a conditioning program. It is present after activity but is absent by the next day’s practice or is relieved by warm-up.

Semi-Harmful Pain

This type of pain indicates that the athlete is starting to get into trouble. Semi-harmful pain is partially relieved by warm-up. It is present during activity but performance is not noticeably reduced. When semi-harmful pain is recognized, the conditioning program should be reduced and the treatment regimen described below should be followed. If the pain lasts more than one week, seek medical attention.

Harmful Pain

This type of pain means the athlete is in trouble. With it, performance is noticeably reduced and is not relieved by rest. A period of rest and medical attention will likely be required before continuing the conditioning program.


Over-use injuries are generally treated by R.I.C.E. (Rest, Ice, Compression, Elevation) + A.R.


Relative rest is provided by determining a level of exercise that produces benevolent pain. This may require rest from the exercise program for a few days.


An ice pack is applied for 1/2 hours on and 1/2 hours off. This is especially important during the first 24 to 48 hours after injury.


An elastic wrap is applied with comfortably firm pressure during and after ice application. The wrap is removed during sleep.


The injured area is elevated above the level of the heart whenever possible. This is especially important during the first 24 to 48 hours.


Re-conditioning is initiated with stretching and then gradually progresses to strength training and measured return to sports participation as benevolent pain allows.

If improvement is not noted in one week, the athlete should seek medical attention to obtain a specific treatment program.

Medicine of the Highest Order